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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2000 February;13(1):1
Surgical treatment of carcinoma of the rectum. A thirty-year experience
Ferri M., Casula G., Scintu F., Cavaliere R., Cosimelli M., Cavaliere F., Tersigni R., Alessandroni L., Vincenti R., Ziparo V., Stipa F., Lucandri G., Fornari F., Stipa S.
Background. The results of surgical treatment of carcinoma of the rectum have been substantially improved in the last decades. The availability of stapling devices, the increasing use of perioperative radiotherapy and the development of endoluminal surgery have all contributed to this progress. In this papers a total of 660 patients resected for carcinoma of the rectum in the last thirty-years were analysed.
Methods. Three-hundred-twenty-two patients (49%) underwent anterior resection (AR) and 280 patients (42%) underwent abdomino-perineal resection (APR). Ninety percent of tumors located in the lower rectum were managed with APR and 97% of tumors located in the upper rectum were managed with AR. Tumors of the middle rectum were treated indifferently with AR or APR. Fifty-eight patients (9%) underwent local excision of the tumor. Most of the lesions (62%) were located in the lower rectum and 60% of patients received adjuvant treatment.
Results. Postoperative mortality rate was 5.2% after AR and 3.6% after APR (p=ns). Among tumors of the middle rectum, local recurrence rate was 17% following AR and 21% following APR (p=ns). Overall 5-year survival rate was 53%. Among tumors of the middle rectum, 5-year survival rate was 64% for AR and 56% for APR (p=ns). Fifty-eight patients (9%) underwent local excision of the tumor. Most of the lesions (62%) were located in the lower rectum and 60% of patients received adjuvant treatment. In patients treated with local excision there were no surgical deaths. The local recurrence rate was 14% in T1 lesions, 25% in T2 lesions and 77% in T3 lesions. No recurrence was observed in 12 consecutive patients with T2 tumor who were submitted to preoperative radiotherapy and whose resection margin was free of tumor. Actuarial 5-year survival rate was 86% in T1 tumors, 73% in T2 tumors and 53% in T3 tumors.
Conclusions. These findings show that AR should be considered as the ³gold standard² for treatment of tumors in the upper and middle rectum; APR should be reserved to tumors located within 5 cm from the anal verge. Small tumors, confined to the rectal wall, can be adequately treated with local excision. Local treatment should be associated to preoperative radiotherapy in tumors involving the muscular layer of the rectal wall.